President Obama's ambitious Global Health Initiative — announced to a receptive international community in 2009 — is faltering as budget constraints and shaky implementation limit the impact of the multibillion-dollar program.

Annika Negin, 22, of Tallinn, Estonia, learned nine months ago she had multi-drug resistant tuberculosis. Doctors said she likely contracted the illness from her father. Negin is committed to taking drugs for another nine to 15 months, and represents part of Estonia's successful approach to fighting TB: persuading patients to take their medication.

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It’s been more than two years since Obama announced his global health program, the Global Health Initiative (GHI), in an eight-paragraph statement from the White House and one year since the administration identified the first eight countries to participate: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda.

But so little has been implemented that many health professionals on the ground in these "GHI Plus" countries know almost nothing about the program.

Obama's pledge was to expand U.S. government focus much more aggressively into other critical global health challenges, such as saving mothers when they give birth or protecting communities from river blindness, instead of the United States continuing to attack diseases like AIDS, tuberculosis and malaria one at a time and without any coordination.

But the reality so far falls dramatically short of the vision. The administration can point only to a few small programs started under GHI in countries around the world, and those are too new or too small to yield any tangible results.

Congress and the administration have entered what appears to be a bitter and prolonged period of budget cutting battles, and foreign assistance in general stands to lose billions of dollars a year. No one believes now that GHI will come close to Obama’s 2009 target of spending $63 billion over six years. In fact, analysts say GHI could receive roughly one-third less funding than anticipated. Funding at that amount would significantly diminish Obama’s vision of a more comprehensive battle for global health.

What happened to GHI? And what happens next? In a series of reports over the coming months from Washington and in capitals around the world, GlobalPost will examine the behind-the-scenes decisions in the Obama administration as well as what diplomats and health experts are doing now to bring GHI to life in what some say is a stumbling approach to an international crisis.